Infant Feeding 2014

1. Infant Feeding 2014 Resident Nutrition Education Session 2-19-2014

2. Objectives • Increase skills at recommending foods and formulas for infants • Increase skills at recommending substitutes for possible feeding intolerance • Increase awareness of resources that can help with infant feeding

3. Calorie Needs for Infants/Toddlers • Infants • 0 to 5 months : 108 kcals/kg / estimate 650/day • Most formulas 20 kcals/oz. • 6 to 12 months:96 kcals/kg/ estimate 850/day • Children • 1 to 3:102kcals/kg/estimate 1,300/day • 4 to 6: 90 kcals/kg/ estimate 1,800/day • 7 to 10: 70 kcals/kg/ estimate 2,000/day

4. 1st month • 8 to 12 feedings per day • watch for signs of hunger not the clock • frequent feedings help build mom’s supply • On demand bottle feeding not clock • greater or equal to 6 wet diapers per day sign baby is drinking enough • check weight to monitor feeding progress

5. Weight gain rate • 4 to 8 ounces per week for the first 6 months • 1 LB every 2 weeks

6. Monitoring Feeding Progress • Weight checks main way to assess if intake is adequate • breastfed babies should be checked several days after discharge since there is not another good way to monitor intake • some initial weight loss is normal • >8% of birth weight lost is excessive • should pass their birth weight by 10 to 14 days

7. Monitoring elimination • Number, size, color of stooling and voiding is another way to tell if breastfed infants are getting adequate calories • colorless, dilute, urine, 6 to 8x per day • urate crystals look like brick dust, may be present in first few days but abnormal if detected any other time • 4th-5th day, stools-small, yellow curds x 4

8. Formula feeding • Ready to feed formulas-no water added • liquid or powered concentrate-mix with water, standard 1 oz. formula with 1 oz. water=20 calories per oz. • calorie goal 108 kcals/kg • do not added cereals, solids, honey, corn syrup • Easy flow nipples increase consumption

9. allergies • 1 to 3% infants have allergy to cow’s milk protein • 10 to 14 days for allergic response to occur after exposure to allergen • severity of signs vary-emesis, bloody stools, dermatitis, anaphylactic shock,

10. Feeding challenge • If allergies suspected change formula for 2 to 4 weeks • use a hypo-allergenic formula, then switch to previous formula • monitor reactions • may want to do under your supervision if reactions were severe • WIC NEEDS MD ORDER/DIAGNOSES • For special formulas

11. Formula Types • Standard milk based formula • soy-based non-milk based, lactose free, lactofree • hypercaloric • Hypoallergenic formulas-Neocate • See handout for brand names/categories

12. Nutrition care manual • https://www.nutritioncaremanual.org/formulary.cfm • Formula Types • Formula recipes to adjust calories • Infant Feeding guides

13. Formula feeding basics • Prepare only amount of formula baby will drink at one time • discard any unused formula to avoid foodborne illness • keep all supplies clean • refrigerate prepared or open formula • check for these steps if GI distress occurs

14. Formula feeding problems • Colicky -switch to hypoallergenic formula for several months • discourage bottle propping

15. Vitamin/ mineral supplements • Fluoride supplements at 6 months if local water supply does not contain fluoride or bottled water used • if exclusively breast fed, start Vit. D 400 IU at birth • iron-start iron fortified cereals at 6 month

16. Breast fed babies supplements • Neonate has adequate iron stores for first 4 months, bioavailability of iron in breastmilk high, supplements not usually given until after 6 months, if even then • Strict vegetarian moms should take B12 supplements

17. Feeding schedules • Use resources to reinforce feeding schedule • schedules should review amts., types, motor skills needed, temperatures, preparation, food safety, and healthy feeding relationship between infant and caretaker • Never FORCE feedings, or force baby to eat all of container

18. Resources • Feeding schedules that can be downloaded from WIC program websites or infant feeding companies • reviews physical, developmental changes and foods that would work with different changes • reviews their foods for each step: 1, 2, 3 • Nutrition Care Manual

19. Focus on Mindful Eating in Infants • Habits start young, avoid being over or undernourished as infant or adult • Turn off TV • Focus on eating and hunger • Establish meal times and routine • Avoid Multi-tasking and rushing feedings • Put away toys • Make eye contact with infant

20. 0 to 4 months • Breast feeding or iron fortified formulas only for the first 4 to 6 months • nursing 8 to 12 times per day, normal at first, reduce to about 4 to 6 times by 4 months (depends of growth patterns) • formula-6 to 8 feedings, 2 to 5 oz. per feeding, with age number of feedings decrease, amount increase to 6 to 8 oz.

21. Shopping for baby foods • First step • Second step • Third step

22. 6 months • Solids can be stated when birth weight has doubled • Do not eat out of jars, put small serving in separate bowl • Rice cereal usually first, only 1 to 2 spoonfuls • Juice at 6 mo.: Only 4 to 6 oz. per day • From cup not bottle • OR start solids when they drink 8 oz. of formula in a sitting and are hungry in less than 4 hours • start solids if infant nurses 8 or more times per day, or consumes more than 32 oz. formula per day

23. 6 to 9 months • Start veggies first • Add strained fruits, vegetables, and juices, only 1 new food every 7 days • usual serving is 2 to 3 T. 2 times/day • Only 2 ounces baby juice from cup • only 30 to 32 oz. of formula or 3 to 5 feedings

24. 9 to 12 months • Add strained or finely chopped meats • only 1 new meat a week • egg yolks only • plain toast and crackers added once teeth are present • cheese, cottage cheese, yogurt, can be added but not cow’s milk • soft chopped vegetables and fruits • formula or breast milk 25 to 30oz., 3 to 4 nursings.

25. 1 to 2 years • Add whole milk at 1 year • add egg whites at 1 year • avoid foods that may cause choking: hot dogs, sausages, popcorn, nuts, round candy, uncooked vegetables, apple chunks, grapes, nuts, seeds, peanut butter • wait for full set of teeth for above foods

26. Special problems • Nursing bottle caries-can be caused by sleeping with bottle of juice, formula or breast milk • water recommended if bottle is needed at bedtime • extra water only needed if newborn is at high risk for dehydration: heat, humidity, diarrhea, etc.